Clinical psychology & psychotherapy
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Clin Psychol Psychother · Sep 2015
Psychometric Properties of Two Brief Versions of the Voices Acceptance and Action Scale (VAAS): Implications for the Second-wave and Third-wave Behavioural and Cognitive Approaches to Auditory Hallucinations.
Despite a steep rise in the evidence base for third-wave cognitive and behavioural therapy approaches over the past decade, a scarcity of change measures relevant to these therapies as applied to psychosis is arguably slowing empirical progress in the area. The Voices Acceptance and Action Scale (VAAS), a measure of acceptance of voice experiences, is a notable exception. However, there are no published data on its psychometric properties outside of that provided by the scale developers. The current study explored the psychometric properties of two brief versions of the VAAS in a sample of psychotic voice hearers in a routine outpatient mental health service. Evidence from the current study suggests that both brief versions are robust measures of acceptance of voice experiences. Some limited support for the shortened VAAS-9 as being a marginally improved scale over the original brief VAAS-12 was also found. The current study found acceptance of voices to be highly related to depression, anxiety, stress and general negative affect and to predict unique variance in depression and general negative affect beyond that attributable to negative beliefs about voices and thought suppression. It was also found that acceptance was positively related to the use of reappraisal, indicating that the distinctiveness of acceptance from appraisal processes may be less pronounced in this context than what was has been reported previously. Implications for future research, as well as the practice of second-wave and third-wave cognitive and behavioural approaches to psychosis, are discussed. ⋯ Two brief versions of the VAAS instrument were found to be robust measures of acceptance of psychotic voice experiences. The construct of acceptance of voices is highly related to indices of well-being and negative appraisal processes in psychosis and appears to offer an alternative route to therapeutically addressing the toxic effects of negative beliefs about voices. The recent focus on acceptance-based techniques within cognitive and behavioural approaches to psychosis was supported.
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Clin Psychol Psychother · May 2015
Revisiting Chronic Pain Patient Profiling: An Acceptance-based Approach in an Online Sample.
Over 116 million Americans experience chronic pain, incurring an annual cost of $635 bn in healthcare and lost work. Acceptance-based therapies have gained increasing recognition for improving functional outcomes. In our online chronic pain sample, we predicted that (1) patients would cluster into low, medium and high groups of chronic pain acceptance and (2) positive affect, negative affect and perceived disability scores would differ overall by cluster, with the most positive outcomes found in the high cluster and the least found in the low cluster. Participants completed the Chronic Pain Acceptance Questionnaire, Positive and Negative Affect Scales and the Pain Disability Index. A k-means cluster analysis was conducted using activity engagement (AE) and pain willingness (PW) totals from the Chronic Pain Acceptance Questionnaire. As predicted, cluster analysis specified three groups: low AE/low PW, high AE/high PW and medium AE/medium PW. Significant multivariate analysis of covariance results were obtained according to Wilks' λ (0.55), F(6,266) = 15.39, p < 0.01, and indicated differences in positive affect, negative affect and perceived disability within each cluster. Follow-up analyses of covariance revealed mean differences in the predicted directions: the high-high group showed the most positive affect and the least negative affect and perceived disability. Conversely, the low-low group displayed the least positive affect (M = 20.28, SD = 7.86), the most negative affect (M = 28.05, SD = 9.33) and perceived disability (M = 49.57, SD = 9.46). The presence of these clusters introduces key questions about the possibility of creating tailored interventions based on cluster profiles. ⋯ Higher levels of Acceptance are associated with better functional and affective outcomes for chronic pain patients. Lower Acceptance is associated with poorer functional and affective outcomes. Tailoring interventions using Acceptance-based profiling may improve chronic pain therapies.
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Clin Psychol Psychother · Jan 2015
Are young people hospitalised with psychosis interested in psychological therapy?
Psychotic clients may be difficult to engage in psychological therapy, and many potential participants decline to participate in controlled trials of cognitive behavioural therapy. The aim of this study was to investigate psychotic patients' perspectives regarding therapy. ⋯ The reasons why some patients with psychosis are not interested in receiving psychological therapy may relate to past negative experiences with psychologists, negative perceptions of psychologists as a group and low perceived efficacy of therapy. These barriers may be addressed through interactions with psychotic patients during an admission to a hospital that disconfirms these perceptions and provides a positive alternative experience with a psychologist. Patients who are hospitalized with psychosis may be interested in receiving psychological therapy; however, the reason for this likely will not be to address psychotic symptoms. Rather, the therapist should be willing to work with the patient on a range of other presenting problems. If a patient has a lack of insight into their psychotic symptoms, this does not always negate them from perceiving other psychological problems for which they may desire support in addressing. Thus, therapists should be encouraged to approach all psychotic patients on a ward, even when there is an apparent lack of awareness of their psychotic symptoms. The themes related to patients' perspectives were generated from psychologists' summaries of interviews with patients and not directly from verbatim transcripts. Although this meant that the reasons given for participants being interested or not interested in therapy were interpreted by the psychologist, efforts were made to relate the exact reasons provided by the participants. Eighteen (29%) of the potential participants were not interviewed, usually as a result of their being discharged or transferred prior to arrangement of an interview. This meant we were unable to capture the views of these patients. Discharge prior to being seen by a psychologist is a barrier to engaging a patient in therapy and preventing them falling through the gaps of service provision.
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Clin Psychol Psychother · Jul 2014
Clinical psychologists' experiences of reflective staff groups in inpatient psychiatric settings: a mixed methods study.
Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow-up interviews were used to gain broad descriptions of practice and in-depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. ⋯ The term 'reflective practice group' encompasses a range of practices, but a typical group structure was found with common aims, outcomes and challenges. Reflective staff groups are regularly facilitated by clinical psychologists in inpatient psychiatric settings in the UK and are influenced by practitioner experience as well as psychodynamic, systemic and group process theories. The safety required for reflective groups to function is influenced by the organizational context, and groups can contribute to shifts in culture toward including psychosocial perspectives. Reflective staff groups represent one type of contribution to an inpatient psychiatric service and team relationships; other processes to encourage alternative professional perspectives and values might also support change. More research is recommended to explore facilitator characteristics, the views of staff teams on reflective staff groups and the impact of these groups on patients.
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Clin Psychol Psychother · Nov 2013
What do service users with bipolar disorder want from a web-based self-management intervention? A qualitative focus group study.
Bipolar disorder (BD) is a chronic and recurrent severe mental health problem. A web-based self-management intervention provides the opportunity to widen access to psychological interventions. This qualitative study aims to identify what an ideal web-based intervention would look like for service users with BD. ⋯ Service users desire a web-based self-management approach that gives them the techniques they need to not only manage their moods but also manage their lives alongside the disorder, including interpersonal and practical issues. Service users describe their primary outcome, not as a cure or reduction in their symptoms, but instead being able to live a fulfilling life alongside their condition. Service users see the internet as their preferred format because of the increased accessibility to evidence-based intervention. Service users discussed the potential barriers to web-based interventions including motivation and procrastination. Effective and acceptable content and low-level support provide potential solutions to these issues.